HX64073254 
RA395.A3  R67  The  relations  of  the 


RECAP 


ROOSA 


THE  RELATIONS  OF  THE  MEDICAL  PROFESSION  TO 
THE  STATE 


RA3^S.to 


Ejol 


Columbia  (Bntoergftp 

COLLEGE  OF 

PHYSICIANS  AND  SURGEONS 

LIBRARY 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/relationsofmedicOOroos 


^*^^^XW^<3  ^.  AoVc^. 


THE    RELATIONS 


Medical    Profession 


TO    THE    STATE. 


BEING  THE  ANNIVERSARY  DISCOURSE  DELIVERED  BEFORE 

THE    MEDICAL    SOCIETY    OF   THE  STATE    OF 

NEW  YORK,  FEBRUARY  FIFTH,   1879. 


D.  B.  St.  JOHX  RODS  A,  M.D., 

PRESIDENT    OF   THE    SOCIETY. 


NEW     YORK: 
Published  by  Order  of  the  Society. 

1879. 


-fid  m&is 


THE    RELATIONS 


MEDICAL  PROFESSION  TO  THE  STATE. 


The  country  in  which  we  live  is  still  a  new  one.  Many  of 
our  forests  are  primitive  and  much  of  our  soil  is  uncultivated. 
Even  in  our  oldest  States  we  may  see  regions  upon  which  man, 
by  his  residence  and  labor,  seems  hardly  to  have  made  a  sensible 
effect.  We  have  scarcely  any  of  the  garden-like  cultivation  of 
England,  we  have  no  wood-parks  like  Ardennes  and  Fontaine- 
bleau,  no  gray  towers  on  our  river  banks,  and  few  of  the  broad 
and  hard  highways  over  which  Moltke's  armies  marched  to 
Sedan  and  Paris.  In  our  vast  country  there  is  a  constantly 
recurring  impression  of  newness,  and,  in  a  certain  sense,  of 
roughness.  I  am  not  unmindful  of  what  we  have  achieved  in 
the  way  of  invention,  manufacture,  commerce,  and  culture.  I 
merely  wish  to  recall  to  your  minds  a  fact  that  we  are  all  per- 
haps inclined  to  forget,  namely,  that  we  are  still  a  new  people 
in  a  new  land.  We  cannot  inherit  the  fullness  of  cultivation 
of  the  older  peoples  in  our  intellectual  work  any  more  than  in 
the  cultivation  of  our  soil.  Our  relations  as  individuals  or  as 
guilds  and  professions,  to  each  other  and  to  the  government, 
must  of  necessity  be  different  from  those  which  obtain  among 
older  nations  with  their  centuries  of  history  and  of  tradition. 
In  Europe  there  has  been  time  for  many  things  to  arrange 
themselves  into  a  refined  system.     The  profession  of  medicine 


2 

in  a  country  like  England,  or  France,  or  Germany,  is  sensibly 
influenced  by  these  conditions  of  age  and  fixity,  and  is  in  cer- 
tain established  relations  to  the  State,  which  make  unnecessary 
many  of  the  discussions  into  which  we  are  constantly  drifting. 
The   ordinary  and   extraordinary  necessities   of   our   govern- 
ment, have   left   little   time   for  such  minor  matters   as   the 
determination   of   the   relations   to   it  of   a   class  which    the 
State  has  practically  declared  to  have  no  formal  connection 
with   the    governing   powers.      The   process  of    arrangement 
is,   however,   now  going   on.      For   the   next   hundred   years 
the  people  of  the  United  States  will  devote  much  time,  not 
only  to  the  refinement  of  their  material  condition,  to  their 
highways  and  hedges,  their  fields  and  lawns,  but  also  to  the 
relations  of  the  various  guilds  into  which  the  people  are  di- 
vided, to  the  State  to  which  all  give  allegiance.     May  I  then 
beg  your  attention  to  a  consideration  in  outline  of  the  relations 
of  the  medical  profession  to  the  State  ?     1  have  said,  deliber- 
ately, that  we  mast  be  engaged  for  the  next  hundred  years  in 
establishing  and  perfecting  them,  for  I  have  no  idea  that  in 
our  generation   we   shall  do  much  more  than  begin  a   work 
which  can  only  be  completed  in  many  decades  of  time.     No 
dream  of  a  homogeneous,  vast,  organized,  and  catholic  body, 
untormented  by  schism  or  disorder,  in  settled  relations  to  the 
civic  authorities,  has  passed  over  my  mind.     I  do  not  anticipate 
that  the  legislation  of  this  or  of  any  subsequent  session  of  our 
ancient  and  honorable  body  will  create  a  medical  Utopia,  but 
I  hope  that  each  one  of  its  meetings  will  accomplish  some- 
thing toward  the  establishment  of  the  medical  profession  in 
such  proper  relations  to  the  State  as  shall  redound  to  our  ad- 
vantage and  honor,  as  well  as  to  that  of  the  commonwealth. 

I  am  not  one  of  those  who  believe  that  we  must  model  all 
our  affairs  after  those  of  the  Old  World,  that  what  is  right  for 
England,  German}7,  and  France  must  of  necessity  be  right  for 
the  United  States  ;  but  I  hold  that  there  must  be  many  things  in 
which  we  shall  improve  upon  the  ways  of  the  older  nations, 
and  that,  from  the  very  nature  of  things,  there  must  be  many 
ways  in  which  our  modes  differ  from  theirs. 

I  will  consider  the  relations  of  the  medical  profession  to  the 
State  under  the  following  heads : 


I. — As  Witnesses  to  Aid  in  the  Detection  of  Crime,  or 

the  Breaking  up  of  Nuisances. 
II. — As  Defendants  in  Suits  for  Malpractice. 
III. — As  Educators  of  the  Physicians  of  the  Future. 
IV. — As   Managers  of  Institutions  for  the  Care  of  the 

Sick  and  Injured. 
V. — As  Protectors  of  the  Community  from  Quackery. 
VI. — As  Sanitary  Advisers  to  the  Commonwealth. 

I. — It  is  probable  that  the  singular  contradictions  of  some  of 
our  medical  experts  have  excited  the  wonder  of  laymen  and  a 
sense  of  shame  in  medical  men.  The  laity  have  sometimes 
asked  if  there  are  really  no  fixed  rules  for  the  determination  of 
the  existence  of  metallic  poisons  in  the  human  body;  if  there  is 
no  evidence  of  insanity  that  may  be  clearly  shown  to  a  jury  ;  if 
there  is  no  standard  as  to  what  is  a  perfect  cure  of  a  fracture; 
and  if  it  be  not  possible  for  the  physicians  of  New  York  to 
agree  as  to  whether  the  noise  from  an  elevated  railway  is  an 
injury  to  the  nervous  system.  We  know,  and  all  intelligent  lay- 
men know,  that  there  must  always  be  different  shades  of  opin- 
ion upon  the  same  subject,  in  a  science  so  unsettled  and  progres- 
sive as  our  own;  but  nobody  yet  knows  why  it  is  that  experts  can 
always  be  found  who  honestly  believe  that  no  antimony  ever 
was  in  a  certain  stomach,  when  it  has  been  already  discovered 
by  supposed  reliable  authority,  or  why  one  man  is  pronounced 
to  be  raving  mad  by  Professor  A.,  and  competent  to  take  charge 
of  vast  estates  by  Professor  B.  Neither  does  any  man  know 
why  Dr.  X.  believes  that  all  broken  limbs  ought  to  heal  with- 
out shortening,  while  a  professional  brother,  of  equal  position, 
positively  states  that  no  legs  ever  unite  without  some  lessening 
in  length.  Neither  do  any  of  us  probably  understand  why  a 
large  number  of  physicians  are  induced  to  say,  that  Ci  perverted 
mental  and  moral  action,  cerebral  exhaustion,  insomnia,  hys- 
teria, chorea,  mania,  paralysis,  meningitis,  and  decay  of  nutri- 
tion," will  be  largely  promoted  by  life  along  an  elevated  rail- 
way, while  other  authorities  state  that  "medical  literature,"  ac- 
cording to  their  belief,  "  does  not  afford  a  single  instance  of 
any  of  these  diseases  being  caused  by  noises  such  as  are  pro- 
duced by  the  cars  on  an  elevated  railway." 


The  system  in  our  law  that  allows  able  and  zealous  lawyers 
to  coach  and  pay  their  own  experts,  until  they  have  made 
honest  partisans  of  them,  is  certainly  vicious.  The  State 
should  summon,  the  State  should  pay  experts,  and  they  should 
act  as  associate  judges,  to  aid  the  real  judge  in  getting  the 
truth  before  the  jury.  The  plaintiff  and  defendant  should  un- 
doubtedly have  the  right  of  putting  their  case  before  the  medi- 
cal experts,  and  exercise  a  choice  in  selecting  them;  but  the 
medical  man  should  receive  his  honorarium  from  the  State,  and 
never  be  put  in  the  position,  as  an  expert,  of  being  a  witness 
for  one  side.  Then  the  physician,  surgeon,  or  chemist  would 
go  upon  the  stand,  so  far  as  it  is  possible  for  human  legislation 
to  attain  such  an  end,  without  fear  and  without  the  idea  of 
favor.  Napoleon  asked  Du  Bois  to  treat  the  Empress  of 
France  in  labor,  as  if  she  were  a  peasant  woman  in  a  hospital, 
instead  of  a  sovereign  in  a  palace.  The  medical  man  should  be 
placed  in  a  position  where  he  may  be  able  to  treat  a  medico- 
legal case  as  he  would  a  dead  body  under  his  scalpel. 

The  subject  of  the  adequate  payment  of  medical  experts 
comes,  of  course,  under  this  head.  As  matters  now  stand, 
physicians  may  be  obliged  to  make  long  journeys,  and  give,  for 
a  mere  pittance,  valuable  opinions,  the  fruit  of  years  of  toil- 
some observation.  It  is  the  opinion  of  many,  which  is  shared 
by  your  speaker,  that  the  whole  subject  of  payment  of  those 
who  work  for  the  government  should  be  carefully  looked  over, 
and  that  such  an  examination  will  show  that  a  great  and 
powerful  State  ought  to  pay  its  servants  so  well,  that  the  best 
men  may  be  claimed  and  secured  for  its  service.  Certainly 
experts  should  not  be  taken  away  from  their  ordinary  duties 
without  a  compensation  that  will,  at  least  to  some  considerable 
extent,  recompense  them.  This  society  has  already  taken 
action  upon  the  subject  of  payment  for  expert  testimony,  by 
appointing  a  committee  to  ask  the  Legislature  to  consider  this 
subject. 

II. — As  Defendants  in  Suits  for  Malpractice. 
It  is  a  matter  of  mortification  that  there  should  be  any  ne- 
cessity for  such  a  relation  of  the  profession  of  medicine  to  the 
State  as  this.     But  physicians  are  unfortunately  not  exempt 


from  the  frailties  and  faults  of  humanity,  and  they  must  ex- 
pect to  answer  at  the  bar  of  justice  for  any  crimes  they  may 
commit.  In  what  I  have  to  $a,y,  there  is  no  claim  for  any  im- 
munity from  punishment  for  neglect  of  duty  or  culpable  ig- 
norance on  the  part  of  a  medical  practitioner;  but  I  shall 
simply  attempt  to  show  how,  under  our  present  system  of 
inquiry,  medical  men  are  at  the  mercy  of  ignorant  jurors  and 
unscrupulous  lawyers.  It  is  often  the  case,  that  after  medical 
men  have  given  their  time  without  fee  or  reward,  they  are  called 
to  account  on  a  charge  of  malpractice  that  has  no  other  founda- 
tion than  that  the  patient  did  not  recover  in  the  manner  that 
he  or  his  friends  thought  he  ought  to  have  done.  I  frankly 
admit,  however,  in  the  outset,  that  we  ourselves  are  in  a  measure 
to  blame  for  the  tone  of  expression  about  the  work  of  physi- 
cians, which  is  somewhat  prevalent  among  the  people. 

It  has  often  pained  many  of  us,  I  am  sure,  to  hear  a  medical 
practitioner  boast,  even  in  the  presence  of  laymen,  of  cures 
that  he  had  made,  when  another  man,  his  peer,  had  blundered. 
This  idea  of  considering  the  result  as  largely  due  to  personal 
and  extraordinary  gifts,  is  the  basis  of  the  notion  among  the 
laity  that  the  attending  physician  is  to  blame  if  an  eye  be  lost,  a 
fractured  limb  be  shortened,  or  if  a  patient  die  from  disease. 
"  If  Dr.  — —  had  not  done  so  and  so,"  or  "  if  he  had  done  so  and 
so,"  in  the  common  phrase,  the  patient  would  not  have  died  ;  or, 
as  I  have  often  heard  it  much  more  strongly  put,  "  I  have 

always  thought  that  Dr. killed  that  person."     This  is  no 

fancy  sketch.  It  is  as  flippantly  and  commonly  asserted  in  or- 
dinary social  circles,  that  physicians  often  kill  patients  by  neg- 
lect or  stupidity,  as  that  plumbers  put  in  defective  material 
and  leave  holes  in  waste-pipes.  In  a  famous  play  of  Moliere's, 
one  of  his  characters  constantly  jeers  at  the  faculty  in  such 
phrase  as  this :  "  All  the  excellence  of  their  art  consists  in 
pompous  nonsense  and  idle  babbling,  which  give  words  for 
reasons  and  promises  for  performance." — toute  V excellence  de 
leur  art  consiste  en  un  pomjjeicx  galimatias,  en  un  specieux  ha- 
bil,  qui  vous  donne  des  mots  pour  des  raisons  et  des  jpromesses 
jpour  des  effets.  No  criticisms  are  more  uproariously  received 
from  a  stage,  than  such  as  these,  even  in  France  where  our 
calling  has  always  been  held  in  high  esteem.     Moliere  well 


6 

expresses  the  tendency  of  society,  and  in  onr  own  time  some  of 
its  most  catting  sarcasms  are  directed  upon  the  ignorance  and 
want  of  skill  of  medical  men.  The  speaker  knows  of  a  social 
discussion  of  the  merits  of  a  celebrated  ocnlist,  which  was  ended 
by  the  serious  assertion  of  a  man  not  at  all  unfriendly  to  the 
subject  of  remark,  in  the  following  way:  "Well,  he  has  put 
out  a  great  lot  of  eyes."  To  lightly  accuse  a  man  of  being 
a  liar,  or  a  thief,  is  still  considered  a  disgrace  in  any  society 
in  our  land;  but  a  doctor  is  imputed  with  malpractice  in 
as  free  and  easy  a  manner  as  the  most  trifling  peccadillo  is 
charged  upon  a  servant.  But  wTe,  as  a  profession,  should  first 
clear  ourselves  from  any  complicity  in  this  kind  of  detrac- 
tion, before  we  turn  upon  those  who  lightly  bandy  charges 
against  medical  men.  If  each  of  us  would  ever  guard  his 
brother's  honor  as  his  own,  and  promptly  avow  a  disbelief  in 
the  charge  of  malpractice  which  is  so  frequently  brought  to  him 
by  a  patient  who  is  about  to  change  his  physician,  the  flippant 
tone  often  observed  in  society  in  regard  to  the  services  of 
medical  men  would  soon  be  changed  to  one  of  respect.  Skill  of 
hand,  years  of  experience  in  the  observation  of  medical  cases, 
are  sometimes  temptations  to  lead  men  to  suppose  that  they  can 
turn  away  the  hand  of  disease  and  death  when  others  have 
failed  ;  but  a  little  sober  thought  of  our  own  impotence  when 
the  inevitable  time  has  come,  will  soon  lead  us  to  an  aversion 
to  any  special  claims  for  healing  power.  Let  us  feel  the  sad  truth, 
that  there  is  a  destiny  that  shapes  the  issues  of  life  and  death, 
rough  hew  them  as  we  may,  and  no  pressure  of  need  for  daily 
bread,  no  desire  for  success  and  fame — above  all,  no  wish  to 
triumph  over  another  physician,  will  ever  cause  us  to  put  our- 
selves in  the  attitude  of  tradesmen  praising  our  wares,  or  of 
skillful  mechanics  promising  to  repair  or  build.  Our  posi- 
tion should  be  rather  that  of  experienced,  careful,  and  cool- 
headed  mariners,  well  provided  with  compass,  chart,  and  lead, 
who  hope  by  the  blessing  of  God  to  bring  the  good  ship  into 
port,  but  who  do  not  claim  to  control  the  fog  and  the  storm, 
which,  in  spite  of  the  most  careful  navigation,  are  sometimes 
the  destruction  of  a  gallant  ship  and  crew. 

There  is  need  for  a  remedy  for  some  of  the  worst  features  of 
these  suits  for  malpractice.     One  of  the  States  of  our  country, 


which  is  always  in  the  van  in  any  progressive  political  or  social 
movement,  has  already  passed  a  law  which  does  away  with  the 
system  of  coroners'  juries  as  it  now  obtains  in  New  York.     By 
this  new  law  of  Massachusetts,  the  office  of  coroner  is  abolished. 
In  his  stead  is  a  medical  examiner,  and  not  until  his  investiga- 
tion as  to  the  causes  of  death  is  ended,  is  there  any  calling 
upon  the  civil  power,  which  then  appears,  if  necessary,  in  the 
form  of  the  district  attorney  and  a  justice,     hi  our  State  the 
coroner  may  not  be  even  a  physician,  and  he  may  be  a  very  ig- 
norant man,  while  the  coroners'  jury  is  usually  obtained  in  the 
easiest  way  possible.     When  we  remember  that  serious  medical 
questions  are  very  often  involved  in  the  decisions  of  such  a 
coroner  and  such  a  jury — questions  affecting  the  reputation  and 
freedom,  perhaps  even  the  life  of  a  physician — we  do  not  wonder 
that  one  State  has  at  last  done  away  with  the  bad  system  to 
which  New  York  still  clings.     Let  me  give  one  instance  from 
many  that  could  be  cited  of  the  workings  of  a  coroner's  jury  in 
our  State.     A  physician  in  New  York  city  was  recently  sum- 
moned as  a  witness  in  the  case  of  a  man  who  had  died  from 
acute  meningitis  resulting  from  an  inflammation  of  the  middle 
part  of  the  ear.     The  relatives  of  the  deceased  had  avowedly 
set  the  investigation  on  foot,  because  they  believed  that  the 
physician   who    was    called    as    a   witness,   had    caused    the 
death  of  the  man  by  a  surgical  operation  which  he  had  per- 
formed upon  the  drum  membrane.     The  friends  and  the  jury 
were  of  a  low  type  of  unlettered  day-laborers.     The  coroner 
had -never  received  a  scrap  of  medical  education,  and  very  little 
of  any  other.     The  theory  of  the  investigators  was  that  the 
instrument  used  to  open  the  abscess  in  the  ear,  had  entered  the 
brain  and  caused  a  fatal  bleeding.     It  was  shown  that  the  man 
walked  away  from  the  place  where  the  operation  was  performed, 
much  relieved  of  severe  pain,  and  that  he  returned  two  days 
after,  expressing  himself  as  much  benefited.     Three  days  after 
this  he  died,  not  having  seen  the  surgeon  after  his  second  visit. 
The  jury  examined  and  cross-examined  the  physician  who  had 
performed  the  operation   as  to  his  skill  and   character,  and 
several  witnesses  of  the  same  intelligence  with  the  jury  testi- 
fied very  freely  as  to  their  opinion  of  the  cause  of  death.     The 
animus  of  the  jury  was  so  marked  that  the  coroner  was  obliged 


to  resort  to  some  urgent  advice  to  prevent  them  from  bringing 
in  a  verdict  which  would  have  compelled  the  surgeon  to  appear 
before  a  grand  jury.  Although  there  was  not  one  shadow  of 
evidence  of  malpractice,  but  rather  of  proper  and  kindly 
treatment  in  a  hospital,  where  as  usual  all  the  services  of 
the  attending  surgeons  are  absolutely  without  fee,  the  jury 
finally  brought  in  the  following  remarkable  verdict :  "  We  the 

jury  come  to  the  conclusion  that came  to  his  death  by  a 

rupture  of  the  blood-vessel  or  small  brain,  or  with  some  instru- 
ment used  by  doctors  unknown  to  the  jury."  Medical  men, 
suspected  or  accused  of  negligence  or  want  of  skill,  should  be 
protected  from  the  wrong  of  an  examination  of  their  case  by 
those  who  have  none  of  the  knowledge  necessary  for  the 
conduct  of  such  an  inquiry.  The  profession  has  long  since 
asked  for  protection  from  another  fault  in  our  system,  which 
allows  a  certain  class  of  lawyers  to  take  up  cases  of  alleged 
malpractice  on  speculation,  as  it  is  called.  Both  in  this  coun- 
try and  in  England,  physicians  are  quite  often  put  to  great 
expense  and  loss  of  time,  in  defending  themselves  from  frivo- 
lous charges,  which  usually  fall  to  the  ground  even  when 
brought  before  a  jury  of  men  utterly  unacquainted  with  the 
science  of  medicine.  The  law  can  probably  give  us  but  little 
relief  from  these  attacks,  for  the  full  right  of  appeal  to  a  court 
for  redress  should  never  be  unduly  restricted.  But  the  law 
can  see  that,  if  tried  we  must  be,  it  shall  be  by  "  careful  judg- 
ment of  our  peers  " — a  right  that  should  never  be  denied  to  one 
of  Anglo-Saxon  blood. 

More  than  this,  we  can  come  to  such  a  correction  of  senti- 
ment in  our  own  profession,  that  it  will  be  impossible  to  find 
medical  instigators  of  unjust  suits.  Most  of  these  frivolous 
cases,  unfortunately  for  our  fair  fame,  depend  upon  the  willing- 
ness of  some  medical  men  to  lightly  assert  that  a  case  has  been 
improperly  treated,  and  that  in  their  skillful  hands  the  result 
would  have  been  different.  One  of  our  remedies  for  unjust 
attacks  upon  the  faithfulness  and  skill  of  medical  men  must 
be  found  in  such  an  elevated  tone  of  professional  sentiment 
as  will  prevent  us  from  imitating  the  vilest  of  birds,  that  are 
said  to  foul  their  own  nests. 


III. — As  Educators  of  the  Physicians  of  the  Future. 

Although,  from  the  very  early  history  of  this  country,  the 
community  has  taken  an  active  interest  in  education,  and  even 
in  special  education — that  of  ministers,  lawyers  and  teachers, 
scarcely  anything  has  been  done  for  the  instruction  of  medical 
students  except  by  the  individual  effort  of  the  men  who  elected 
themselves  to  be  professors  in  the  medical  colleges  which  they 
founded.  In  the  State  of  New  York,  at  an  early  date,  there 
was  an  attempt  at  a  medical  college  which  should  be  a  depart- 
ment of  King's  College,  now  Columbia.  In  this  the  European 
idea  of  responsibility  of  the  faculty  to  a  Senatus  Academicus 
was  a  feature  ;  but  this  state  of  things  did  not  continue,  and  to- 
day not  one  of  the  leading  medical  colleges  of  the  State  is  any- 
thing more  than  a  first-class  educational  establishment,  owned 
and  practically  controlled  in  all  its  details  of  financial  manage- 
ment and  appointment  of  professors,  by  a  body  usually  of  seven 
men.  They  are  at  the  same  time  proprietors  and  teachers,  just 
as  much  as  "John  Jones,  A.M.,"  is  proprietor  of  and  professor 
in  "  the  famous  and  large  boarding-school  situated  on  the  banks 
of  the  Hudson,  in  full  view  of  the  Catskill  Mountain  House  and 
the  haunts  of  Rip  Tan  Winkle."  As  a  matter  of  course,  the  an- 
nouncements and  circulars  of  these  colleges  betray  their  private 
character,  and  offer  the  most  flattering  inducements  to  their 
patrons,  while  their  buildings  are  surmounted  by  flagstaffs  from 
which  float  their  emblazoned  banners.  The  contrast  between 
the  announcements  of  medical  colleges  in  this  country  and  the 
catalogues  of  the  Universities  of  Vienna,  Berlin,  and  Stras- 
burg,  with  their  sober,  unpretentious  detail  of  the  names  of 
teachers  and  the  facilities  open  to  the  aspirant  for  medical 
knowledge,  is  not  at  all  creditable  to  our  sense  of  propriety 
and  good  taste.  All  that  the  State  has  to  do  with  these  col- 
leges is  to  prescribe  that  students  in  them  shall  study  three 
years,  that  they  shall  be  twenty-one  years  of  age  when  they 
graduate,  at  which  time  they  shall  also  be  possessed  of  a  good 
moral  character.  From  the  beginning  to  the  end  of  the  course 
of  study,  the  men  who  teach  in  our  medical  schools  are  abso- 
lutely masters  of  the  situation,  and  the  ultimate  judges  as  to  the 
qualifications  of  those  whom  they  send  forth.     The  State  vir- 


10 

tually  says,  and  the  community  still  more  positively:  While  we 
have  an  interest  in  the  quality  of  our  lawyers,  and  we  see  to  it 
that  the  various  religious  bodies  look  after  the  character  of 
their  ministers,  and  we  educate  teachers  at  the  public  cost, 
we  leave  the  whole  business  of  making  medical  men  to  the 
private  institutions  where  they  are  instructed.  It  is  true  that  in 
some  of  these  colleges  there  is  a  titular  connection  with  so-called 
universities,  but  he  who  makes  the  acquaintance  of  the  manag- 
ing boards  of  these  institutions  soon  finds  that  they  have  an 
actual  contempt  for  the  idea  that  it  is  any  part  of  the  duty 
of  a  board  of  councillors  or  regents  to  look  after  the  charac- 
ters or  acquirements  of  the  men  whose  diplomas  they  are  sign- 
ing. They  are  not  at  all  unwilling,  however,  to  publish  the  list 
of  medical  students  in  long  columns,  and  upon  the  credit  of  it 
take  to  themselves  the  name  of  a  university.  But  to  these 
directors  medical  education  is  entirely  a  private  affair.  So  far 
from  encouraging  a  close  union  between  the  departments  really 
united  to  the  governing  board  of  the  college  or  university,  they 
have  been  known  in  some  cases  to  actually  tax  the  medical 
department  for  the  honor  of  being  connected  to  such  a  step- 
mother. It  is  greatly  to  the*  credit  of  the  medical  colleges  of 
this  State  that  they  have  maintained  medical  teaching  at  a  high 
standard,  in  spite  of  such  a  system  and  such  an  indifference 
and  hostility  as  have  been  delineated.  Whatever  may  be  said 
to  the  contrary,  any  exact  examination  will  show  that  the  medi- 
cal teachers  of  the  State  have  always  been  foremost  in  the  efforts 
to  extend  sound  knowledge.  Actual  count  will  show  that  their 
books  furnish  the  most  by  far  of  those  published  on  medicine, 
and  that  their  papers  greatly  outnumber  those  presented  at  the 
meetings  of  medical  societies  by  their  fellow-members  of  the 
profession.  Apt  as  is  the  medical  press  to  decry  medical  pro- 
fessors, it  may  be  safely  asserted,  that  the  temptations  of  their 
irresponsible  position  have  not  overcome  them,  but  they  are 
among  the  chief  promoters  of  scientific  culture.  Something 
better  than  a  desire  to  advertise  themselves  and  to  secure  a  pe- 
cuniary reward,  has  usually  animated  the  men  avIio  have  founded 
and  maintained  our  colleges.  Admitting  all  this,  there  are 
so  many  evils  in  the  present  system,  as  it  obtains  in  all  but 
one  of  the  medical   colleges  of  this  State,  that  a  change  is 


11 

imperatively  demanded.  We  need  an  examination  for  admis- 
sion, a  graded  and  fuller  course,  and  a  more  rigorous  final 
examination.  The  only  problem  to  be  solved  is,  how  shall  we 
secure  these  ends?  1  think,  if  we  turn  our  eyes  again  to  the 
State  of  Massachusetts,  we  shall  find  there  the  only  certain 
means  of  reforming  our  medical  colleges.  But  I  hold  that  the 
State  cannot  undertake  the  work. 

In  a  country  where  there  are  sects,  and  dangerous  sects  in 
medicine,  where  men  who  are  ignorant  of  anatomy  and  physi- 
ology are  rated  as  physicians,  the  work  of  an  examining  board 
appointed  by  political  authority,  that  owes  allegiance  to  the 
people — to  whom  all  so-called  doctors,  whether  sons  of  seventh 
sons,  bone-setters,  patent  medicine  makers,  or  graduates  of 
colleges  and  hospitals,  are  alike — would  be  a  farce.  Whatever 
may  be  proper  for  England  and  Germany,  the  United  States 
are  not  yet  ready  for  an  alliance  of  medicine  with  the  State. 
Neither  do  I  believe  that  this  society  or  any  other  society  can 
successfully  undertake  the  supervision  of  the  medical  colleges. 
The  older  members  of  this  society  can  tell  us  of  the  failures 
of  the  system  of  censors,  and  we  know  how  the  last  law 
in  regard  to  examinations  by  county  societies  has  succeeded 
simply  in  legalizing  every  kind  of  a  nominal  physician.  But 
observe  what  has  been  done  by  the  President  of  Harvard  Uni- 
versity. With  great  ability  and  far-sightedness  he  has  brought 
its  medical  school  into  close  and  responsible  relations  to  his 
Board  of  Trustees  as  a  part  of  his  scheme  of  raising  a  college 
to  the  dignity  of  a  university.  He  has  taken  it  out  from  its 
independent  position  and  made  it,  like  academic,  law,  scien- 
tific, dental,  and  theological  departments,  a  part  of  a  whole. 
That  once  done,  professors  once  independent  of  the  favor 
of  students,  the  existence  of  the  school  no  longer  dependent 
upon  numbers,  all  needed  reform  became  possible.  Harvard 
has  led  where  we  must  sooner  or  later  follow.  The  Univer- 
sity of  Pennsylvania  has  also  taken  a  step,  although  not  a 
very  long  one,  in  the  same  direction,  and  the  medical  college 
at  Syracuse  as  well  as  the  medical  department  of  Union 
University  adopt  the  Harvard  plan.  The  sentence  against 
the  voluntary  and  irresponsible  system  has  been  pronounced  by 
the  higher  sense  of   the  medical  profession.      There  is  some 


12 

delay  in  carrying  it  into  effect,  but  of  the  final  result  there  can 
be  no  doubt. 

This  intimate  connection  of  medical  colleges  with  boards 
of  trustees  is  only  to  be  secured  by  a  recognition  of  the  true 
status  of  medical  departments  of  universities  and  by  endowment. 
The  State,  as  such,  however  much  we  may  ask  of  its  individual 
members,  should  not  be  expected  to  assist,  even  much  less  to  en- 
dow, medical  colleges.  Neither  special  education  nor  special 
charity  should  be  the  function  of  a  republican,  as  contradistin- 
guished from  a  paternal  government.  We  have  not  passed 
through  one  hundred  years  of  independent  government  to  at  last 
be  bound  in  the  swaddling-clothes  of  infancy.  Besides,  if  there 
were  no  other  good  reason  against  governmental  endowment, 
it  would  not  be  safe  for  our  catholic  profession  to  seek  and 
secure  an  alliance  with  the  State  until  the  average  legislator 
knows  the  difference  between  the  man  who  is  a  physician 
and  the  man  who  calls  himself  one.  The  profession  itself 
should  secure  these  endowments.  We  should  begin  to  use 
our  powers  with  wealthy  and  influential  laymen,  and  secure 
for  the  cause  of  sound  medical  education  its  share  of  public 
regard.  It  is  our  own  fault  that  even  intelligent  men  know 
nothing  of  the  subject,  and  consequently  have  no  interest 
in  it.  A  prominent  man  in  one  of  our  cities,  himself  one  of 
the  governing  board  of  a  college  with  a  medical  department 
attached,  whose  diplomas  he  was  in  the  habit  of  signing,  once 
told  a  teacher  in  that  department  that  he  supposed  medical 
students  graduated  after  one  year's  study ;  and  another  member 
of  a  governing  board  of  a  university  in  this  country,  once  said 
that  he  had  yet  to  learn  that  medical  education  formed  any 
part  of  university  training.  If  educated  laymen  do  not  know 
that  a  real  university  should  have  a  medical  school  as  a  part 
of  it,  and  that  they  have  a  vital  interest  in  the  quality  of  doctors 
sent  out  to  practise  among  them  and  their  families,  we 
must  teach  them  all  this.  Then  they  will  endow  our  schools, 
and  give  them  the  facilities,  and  cause  them  to  make  the  ad- 
vances demanded  by  our  time.  Here  is  the  kernel  of  this 
whole  matter  of  reform  in  medical  education.  Anatomical, 
chemical  and  physiological  chairs,  and  laboratories  in  colleges, 
and  cliniques  in  hospitals,  should  be  properly,  although  not 


13 

extravagantly  endowed,  so  that  medical  schools  ma}7  be  main- 
tained even  without  excessively  large  classes.  The  present 
necessary  laxity  in  admissions,  and  in  final  examination,  fairly 
overwhelms  the  land  with  physicians.  Many  of  them  are 
only  so  by  title.  What  was  adequate  in  requirement  for 
1779  is  not  sufficient  for  a  hundred  years  later.  Our  good 
medical  colleges  have  all  resorted  to  makeshifts  in  reform, 
but  all  the  new  demands  are  voluntary  and  not  obligatory, 
so  that  if  a  man  chooses  he  may  graduate  in  our  State 
with  large  acquirements  ;  but  if  he  do  not  so  choose,  or  if 
he  is  not  able  to  do  so,  he  may  get  a  diploma  with  very  mod- 
erate attainments.  I  am  not  one  of  those,  however,  who  be- 
lieve that  a  proper  system  will  of  itself  turn  out  good  medical 
men,  or  that  any  amount  of  education  will  compensate  for  want 
of  brains.  A  man  may  be  graduated  from  a  college  here  and 
study  abroad,  and  yet  be  utterly  incompetent  to  practice  med- 
icine ;  while  a  college  education  and  foreign  travel  are  of  ines- 
timable value  to  nearly  all  who  are  fortunate  enough  to  get  them 
and  wise  enough  to  appreciate  their  advantages.  When  John 
Hunter,  who  could  barely  read  and  write  at  twenty  years  of  age, 
heard  that  he  was  reproached  by  a  rival  with  being  ignorant  of 
the  dead  languages,  he  replied :  "  I  would  endeavor  to  teach 
him  that,  on  the  dead  body,  which  he  never  knew  in  any  lan- 
guage, living  or  dea.d." 

Our  colleges  must  be  made  better  then,  by  being  considered 
as  one  of  the  objects  of  philanthropic  aid,  as  well  as  art  galle- 
ries, observatories,  schools  of  science  and  of.  theology.  I  doubt 
if  one  hundred  thousand  dollars  has  ever  been  contributed  in 
this  State  toward  the  cause  of  medical  education.  But  how 
shall  this  overtaxed  and  heavily  burdened  community  find  the 
means  for  this  new  call  upon  its  benevolence  ?  By  sparing 
from  its  useless  expenditures  that  which  is  here  so  much  needed. 

In  the  little  churchyard  at  Stoke-Pogis,  marked  only  by  his 
name,  lie  the  remains  of  the  immortal  man  who  wrote — 

"  Can  storied  urn  or  animated  bust 

Back  to  its  mansion  call  the  fleeting  breath  ; 
Can  honor's  voice  provoke  the  silent  dust, 
Or  flatt'ry  soothe  the  dull,  cold  ear  of  death  ?  " 


14 

In  spite  of  these  words,  which  should  have  an  influence  where- 
ever  our  tongue  is  known,  our  beautiful  cemeteries,  where  may 
ever  grow  the  rose,  the  violet,  and  the  forget-me-not,  con- 
tinue to  be  disfigured  by  costly  sarcophagi  and  monuments,  and 
to  be  associated  with  funereal  pomp.  The  money  thus  used 
could  well  be  given  where  it  might  aid  to  lengthen  life  or 
mitigate  disease. 

The  State  has  yet  much  to  do  in  the  matter  of  legalizing  the 
dissection  of  unclaimed  dead  bodies.  This  is  a  difficult  matter 
to  manage.  The  chief  trouble  lies  in  the  natural  repugnance 
of  the  human  race  to  the  mutilation  of  the  bod}7  after  the  spirit  has 
left  it.  We  bury  our  dead  with  a  tenderness  and  care  that  show 
how  we  reverence  the  temple  in  which  the  soul  was  enshrined. 
The  humblest  and  the  poorest  share  this  sentiment  with  the 
noblest  and  most  affluent.  Yet,  without  the  dissection  of  dead 
bodies,  without  the  careful  rehearsal  of  surgical  operations, 
anatomical  knowledge  and  skill  in  surgical  work — knowledge 
and  skill  necessary  to  save  life,  are  impossible.  The  sugges- 
tions of  some  wild  sentimentalists  in  our  own  profession,  and 
of  tender-hearted  journalists,  that  we  shall  get  our  knowledge 
and  skill  from  models,  is  simply  puerile.  Who  would  know- 
ingly trust  his  life  or  limbs  to  a  surgeon  who  had  never  traced 
out  the  nerves,  muscles,  and  blood-vessels  on  the  dead  body, 
but  who  had  only  studied  anatomy  on  wax  models  ?  The  pub- 
lic was  deeply  stirred  last  winter  by  the  desecration  of  the 
graves  of  honored  public  citizens  in  a  distant  State.  Indigna- 
tion waxed  hot  because  some  of  the  underlings  of  a  medical 
college  had  robbed  the  abode  of  the  dead.  None  of  us  have 
aught  to  say  in  extenuation  of  the  misdemeanor  of  those  who  vio- 
lated the  sanctities  of  the  grave.  Yet  we  may  urge  the  State 
of  Ohio,  and  all  other  States,  to  facilitate  the  necessary  study 
of  anatomy  and  surgery  among  students  and  practitioners  by 
allowing  medical  colleges  to  freely  use  all  the  unclaimed  dead 
bodies,  of  which  there  are,  unfortunately,  many  on  this  sad 
earth.  Let  us,  as  a  profession,  never  for  a  moment  permit  the 
notion  to  become  popular,  that  we  can  attempt  to  teach  or  to 
practise  without  a  knowledge  of  the  human  frame  derived 
from  actual  study  of  its  structure  in  the  dissecting-room  and 
on  the  post-mortem  table. 


15 


TV. — As  Managers  of  Institutions  for  the  Care  or  the 
Sick  and  Injured. 

There  is  a  widely  diffused  belief  among  business  men  and 
lawyers,  that  physicians  and  clergymen  have  very  little  of  the 
ordinary  tact  necessary  for  the  financial  care  of  large  interests. 
It  is  undoubtedly  true  that  men  thoroughly  devoted  to  the 
high  matters  of  the  care  of  morals  and  health  cannot  at  the 
same  time  give  much  attention  to  strictly  business  affairs. 
Bat,  in  any  economical  plans  involved  in  the  care  of  the  souls 
and  bodies  of  their  two  charges,  the  two  professions  show  an 
astuteness,  and  manage  their  affairs  with  a  success,  that  may 
safely  invite  comparison.  A  devotion  to  religion  or  science 
is  not  at  all  incompatible  with  correct  business  ideas  as  to  the 
erection  and  maintenance  of  a  church  or  hospital. 

Some  of  the  great  minds  of  the  world  have  been  famous  for 
the  ability  with  which  they  carried  out  the  details  of  their 
calling.  Samuel  Smiles  says  that  it  was  because  the  Duke 
of  Wellington  was  a  first-rate  business  man,  that  he  never  lost 
a  battle.  People  are  beginning  to  get  over  the  notion,  if  they 
ever  entertained  it  seriously,  that  true  genius  despises  the 
wisdom  of  this  world.  A  man  is  none  the  less  a  cool  surgeon, 
a  wise  physician,  because  he  attends  to  his  own  financial  affairs 
and  those  of  his  hospital  with  care.  There  is  really  nothing 
in  the  idea  that  a  physician  may  not  be  as  good  a  manager  of 
economical  and  financial  interests  as  a  lawyer  or  a  banker. 
Not  because  he  is  a  good  physician,  but  because  to  be  a  good 
physician  he  must  first  be  a  good  man.  The  history  of  an 
average  business  career  in  this  country  is  not  so  flattering  that 
the  class  which  represent  it  can  afford  to  claim  an  exclusive 
knowledge  of  how  to  manage  hospitals  and  asylums.  The 
record  of  the  management  of  the  army  hospitals  during  the 
civil  war,  by  physicians  and  surgeons  of  the  army  of  the 
country,  is  a  complete  answer  to  those  who  would  put  away 
medical  men  from  the  care  of  their  own.  Distrust  of  the 
business  and  executive  capacity  of  medical  men,  mingled  with 
a  notion  that  they  are  contentious,  are  the  real  reasons  for  the 
almost  universal  exclusion  of  medical  men  from  the  governing 
boards  of  hospitals  and  dispensaries.     Yet  this  distrust  is  not 


16 

founded  on  facts.  Physicians  may  have  been  unfit  managers 
of  affairs  when  they  were  men  of  the  cloister  and  the  library, 
when  they  spent  their  time  in  reading  the  theories  and  fancies 
of  other  men,  or  when  they  devoted  weary  nights  to  the  cru- 
cible and  the  discovery  of  the  elixir  of  life.  But  we  have 
changed  all  this.  The  long  gown  of  the  study  and  the  gold- 
headed  cane  of  the  consulting-room  have  been  put  aside  for 
the  dress  and  equipment  of  an  active  life.  Medical  learn- 
ing now  depends  upon  close  study  of  the  human  frame  itself, 
and  not  of  ponderous  folios — upon  practical  experiments  in  the 
laboratories  and  exact  observation  in  the  sick-room  by  the 
aid  of  all  kinds  of  physical  instruments,  and  not  upon  the 
development  of  fancy-woven  theories  that  had  no  basis  except 
in  the  disordered  minds  of  their  inventors.  The  well  educated 
and  well  trained  physician  of  to-day  may  manage  a  hospital 
with  a  facility  quite  equal  to  that  of  a  man  learned  in  dry 
goods,  politics,  or  the  stock  board.  It  is  evident  that  the 
genius  of  our  time  has  not  only  changed  the  character  of 
the  medical  profession,  but  also  enlarged  its  sphere  to  a 
remarkable  degree.  We  are  being  educated  up  to  the  re- 
sponsibilities which  the  demands  of  the  age  have  thrust  upon 
us.  Neither  the  community  nor  physicians  have  yet  come 
to  a  full  appreciation  of  these  facts.  Hence,  the  old  con- 
dition of  things  obtains.  Hospitals  are  built  without  medi- 
cal or  sanitary  advice,  by  gentlemen  who  have  acquired  their 
notions  of  hygiene  by  years  of  study  of  clay-books,  ledgers, 
and  real  estate  investments,  interspersed  with  a  grand  tour  of 
Europe,  during  which  they  have  visited  the  badly  planned 
hospitals  of  Paris ;  and  they  are  officered  by  philanthropists 
who  think  the  only  safe  way  for  those  who  value  sound  finan- 
cial management,  as  well  as  peace  and  quietness,  is  to  keep 
the  doctors  out  of  boards  of  direction.  Some  of  the  hospitals 
erected  by  laymen,  in  the  full  light  of  what  was  shown  by 
the  hospitals  built  by  the  profession  during  the  late  war,  are 
very  far  from  being  models  of  economical  and  healthy  struc- 
ture. The  cost  of  taking  care  of  patients  in  some  of  the  grand 
buildings  of  England  and  America  is  equal  to  that  of  board  at 
our  first-class  hotels,  with  the  services  of  a  nurse  and  a  consulting 
and  attending  physician  included  in  the  bill.     Put  physicians 


17 

in  fair  proportion  on  the  boards  of  erection  and  management 
of  hospitals,  and  we  would  soon  change  all  this,  and  inaugurate 
in  civil  hospitals  the  system  that  has  given  to  the  medical 
officers  of  the  United  States  Army  a  wide  and  enduring  fame. 

V. — -As  Proti<xtors  of  the  Community  from  Quackkry. 

In  the  discussion  of  this  part  of  our  theme,  there  is  at  the 
outset  a  difficulty  in  definition.  There  is  no  difficulty  with  us 
who  are  of  the  profession,  but  in  the  minds  of  those  who  are 
not  in  our  calling.  An  average  man,  even  a  college-bred  man, 
is  very  apt  to  consider  medicine  as  an  experimental  art,  with 
not  much,  if  any,  science  about  it ;  for  operative  surgery  he 
may  have  some  respect ;  but  medicine  is  so  largely  a  matter  of 
guess-work,  that  to  many  such  men  the  opinion  of  a  person 
who  has  no  exact  knowledge  of  the  human  frame  is  as  valu- 
able as  that  of  the  most  learned  and  experienced  practitioner. 
When  such  a  man  is  seriously  ill  he  waits  eagerly  for  his  phy- 
sician, and  professes  great  estimation  of  his  aid.  "When  merely 
ailing,  however,  he  does  not  hesitate  to  prescribe  for  himself,  or 
to  accept  the  prescriptions  of  any  person  whom  he  may  chance 
upon,  and  who  is  willing  to  tender  him  advice.  He  will  also 
visit  Saratoga  or  Richfield,  and  enter  upon  a  course  of  treat- 
ment b}7  means  of  the  waters  there,  without  dreaming  that  it 
might  be  well  to  take  the  advice  of  a  physician  before  resort- 
ing to  such  active  medicines  as  are  contained  in  Congress  or 
sulphur  springs.  I  think  it  is  Mark  Twain  who  tells  the  story 
of  a  sea-captain  who  had  a  chest  of  medicines,  with  a  book, 
and  various  remedies  numbered  according  to  directions  in  the 
book.  On  the  occasion  of  the  illness  of  one  of  his  sailors,  the 
captain  found,  on  consulting  his  manual,  that  No.  14  was  the 
medicine  required.  No.  14  happened  to  be  out,  but  on  reflec 
tion  he  concluded  that  a  combination  that  would  make  those 
numbers  would  do  as  well.  He  accordingly  prescribed  10  and 
4,  and  was  very  much  surprised  that  a  burial  at  sea  was  the 
result  of  his  scientific  experiment.  Very  few  people  venture 
to  give  opinions  in  regard  to  purely  mechanical  employments, 
unless  they  are  trained  to  them;  but  the, whole  community, 
educated  and  ignorant  alike,  are  quite  willing  to  prescribe  for 
disease,  and  to  explain  physiological  phenomena.  At  not  very 
2 


18 

long  intervals  our  newspapers  give  us  highly  colored  -sketches 
of  the  woman  who  has  been  unable  to  leave  her  bed  for  years, 
who  cannot  use  her  hands  naturally,  and  yet  does  wonderful 
things  with  them  ;  who  sees  with  her  eyes  closed  better  than 
those  of  us  who  have  ours  open,  who  lives  without  eating,  and 
who  is  altogether  a  supernatural  being.  Sympathizing  friends 
gather  around  the  poor  hysterical  and  epileptic  sufferer,  the 
victim  of  disease  of  the  nerves  and  of  excessive  sympathy,  and 
as  they  go  away  proclaim  the  modern  miracle.  The  press 
and  the  clergy  vie  with  each  other  in  their  sensational  accounts, 
and  in  some  instances  they  are  aided  and  abetted  in  this  work 
by  members  of  our  own  profession.  If  such  cases  as  these 
come  to  be  regarded  as  real  exceptions  to  the  laws  governing  dis- 
ease and  the  functions  of  the  body,  we  may  as  well  put  the  dial 
marking  medical  progress  back  to  the  dark  ages,  and  assimilate 
our  views  of  God's  government  of  the  world  to  those  of  Cotton 
Mather  and  his  fellow  witch-executioners.  These  things  show 
how  far  we  are  from  a  rational  view  of  the  science  of  medicine, 
and  the  cognate  subjects.  They  also  show  how  much  remains 
for  us  to  do  in  creating  and  maintaining  a  healthy  public  senti- 
ment. A  connivance  with  wonder-mongers,  and  miracle- 
workers  greatly  delays  the  day  when  our  science  and  art 
shall  receive  the  full  respect  of  the  laity.  I  have  no  time  to 
adequately  discuss  the  subject  as  to  whether  there  is  or  is  not 
a  science  of  medicine.  That  there  is,  we  know ;  that  there  is 
a  science  both  in  the  administration  of  drugs,  and  still  more 
perhaps  in  refraining  from  giving  them,  we  are  all  sure; 
but  how  are  we  to  expect  a  community  that  for  centuries 
has  had  thrust  upon  it,  without  protection  from  the  State,  races 
of  bone-setters  and  clairvoyants,  and,  still  worse,  of  men  and 
women  without  even  a  rudimentary  knowledge  of  the  structure 
and  functions  of  the  human  body — a  community  whose  ears  have 
been  deafened  by  the  din  of  the  sects  as  they  have  vaunted 
their  systems  of  cure — how  can  we  expect  them  to  define  a 
charlatan  or  quack,  when  they  still  believe  that  a  knowledge  of 
the  practice  of  medicine  is  a  divine  gift,  that  may,  like  the 
poetical  genius,  be  developed  in  the  brain  of  an  illiterate  plow- 
man, or  be  the  heritage  of  a  seventh  son  of  a  seventh  son  ? 
While  we  may  not  ask  the  State  to  endow  medical  schools, 


19 

we  may  certainly  expect  that  it  will  protect  its  citizens  from 
well-defined  quackery.  It  certainly  cannot  discriminate  in 
regard  to  modes  of  treatment,  when  there  must  always  be  such 
honest  difference  of  opinion.  The  State  cannot  catalogue 
the  drugs  that  may  be  used,  or  name  the  doses ;  but  it  is 
the  bounden  duty  of  a  Government  that  cares  for  the  welfare 
of  its  inhabitants,  to  see  to  it  that  no  one  is  allowed  to 
prescribe  for  diseases  who  has  not  furnished  evidence  of  a 
satisfactory  knowledge  of  anatomy,  physiology,  and  chemis- 
try. It  should  also  interfere  to  prevent  the  sale  of  so-called 
patent  medicines,  and  of  adulterated  medicines  and  food. 
A  State  that  will  not  do  this  should,  in  all  consistency, 
allow  mad  dogs  to  run  in  the  streets,  lunatics  to  go  at  large, 
and  gunpowder  to  be  stored  in  every  house,  and  leave  its  rail- 
road crossings  without  guards  or  signals.  There  would  be 
no  abridgment  of  the  rights  of  the  citizen  in  such  a  protec- 
tion. If  a  man  does  not  know  enough  to  guard  himself  from 
the  advice  of  those  who  prescribe  for  a  machine  of  which 
they  do  not  know  the  mechanism,  the  State  should  interfere 
to  protect  him,  just  as  it  provides  the  commonest  means  for 
public  safety,  by  means  of  the  police  and  the  army. 

What  is  wTanted  is  a  board  of  examiners,  made  up  of  the  best 
men  from  the  colleges  and  the  profession,  who  shall  determine, 
not  the  orthodoxy  of  a  candidate  as  to  the  doses  of  drugs,  or  the 
uses  of  cold  water  and  vegetable  medicines,  but  as  to  whether  he 
has  been  well  grounded  in  the  structure  and  functions  of  the 
human  bod}7,  the  remedies  for  poisons,  the  rules  for  action  in 
emergencies,  and  the  principles  of  diagnosis,  a  knowledge  of 
which  will,  at  least,  protect  his  patients  from  scandalous  mal- 
practice. If,  however,  civil  service  reform  has  not  reached  a 
point  that  assures  us  that  the  board  can  be  appointed  solely  on 
the  ground  of  professional  fitness,  and  without  the  taint  of 
partisan  politics  upon  it,  we  are  better  off  as  we  are  now,  with 
no  guards  whatever  except  those  that  we  set  up  among  our 
own  members. 

YI. — As  Sanitary  Advisers  to  the  Commonwealth. 
This  is  perhaps  the  most  comprehensive  and  important  of 
any  of  our  relations  to  the  State.     It  is  the  one  now  receiving 


20 

general  attention,  and  there  is  a  prospect  of  its  proper  ad- 
justment. There  are,  however,  still  many  obstacles  on  the 
part  of  the  powers  that  be,  in  the  way  of  yielding  to  physicians 
as  a  class,  even  in  matters  purely  sanitary.  We  here  meet  the 
same  difficulties  that  we  have  already  discussed  under  other 
heads. 

Physicians  are  still  very  largely  regarded  as  fit  only  for  the 
necessary  but  narrow  walk  of  their  calling — in  prescribing  for 
disease  that  has  already  broken  out,  and  for  taking  charge  of 
accidents  that  have  already  occurred.  Preventive  medicine, 
which  you  and  I  are  most  anxious  about,  is  not  yet  fully  ap- 
preciated by  our  law-makers.  A  physician  is  often  considered 
as  a  kind  of  fire-extinguisher,  to  be  sent  for  in  case  of  a  con- 
flagration, but  as  rather  a  useless  member  of  the  body  politic 
when  there  is  no  actual  crisis.  We  are  not  singular  in  being 
thus  unappreciated.  Lawyers  are  the  most  valuable  and  most 
occupied  in  the  prevention  of  litigation ;  soldiers  are  chiefly 
useful  to  avert  war ;  and  yet  advocates  and  soldiers  are 
very  often  regarded  as  of  no  use  except  in  the  court-room 
and  on  the  battle-field.  To  think  in  this  way  is  to  wholly 
misunderstand  the  work  of  the  professions.  There  is  a  kind 
of  exultation  in  the  remark  that  a  physician  has  not  made  a 
professional  visit  to  the  household  during  the  year.  So  far  as 
immunity  from  actual  disease  goes,  this  delight  is  as  proper  as 
it  is  natural,  but  many  a  man  and  woman  who  smile  at  the  idea 
of  the  need  of  medical  advice,  are  walking  surely  to  the  edge 
of  a  precipice  from  which  sound  counsel  might  keep  them. 

The  physician  should  have  the  same  prerogative  in  the 
State  as  in  the  family,  and  no  man  can  be  properly  said  to  be 
a  conscientious  physician  who  does  not,  if  allowed,  have  a  gen- 
eral, vigilant,  but  not  impertinent  oversight  of  the  hygienic 
arrangements  of  the  household  of  which  he  is  the  sanitary  in- 
spector and  adviser.  There  should  be  a  board  of  health  in 
every  county  and  in  every  town,  and  this  board  should  have  no 
man  upon  it  who  has  not  a  medical,  scientific  or  legal  education. 
Not  a  school-house,  not  a  jail,  not  a  hospital,  not  a  sewer,  should 
be  built  unless  competent  sanitary  advice,  with  power  to  en- 
force it,  be  given.  There  are  many  other  things  of  which 
physicians  should  have  the  oversight,  which  are  now  entirely 


21 

neglected.  As  instances  of  these  may  be  mentioned  the  super- 
vision of  the  hygienic  condition  of  prisons,  public  charities, 
private  and  public  insane  asylums.  A  supervision  that  is  con- 
nected with  the  ordinary  management  of  these  places  is  not 
sufficient,  however  careful  and  conscientious  may  be  the  officers. 
Experience  has  shown  that  routine  habits  may  be  acquired, 
which  only  vigilant  governmental  supervision  will  prevent. 

The  attention  of  the  medical  profession  has  been  lately  called, 
both  in  Europe  and  our  own  country,  to  the  great  proportion 
of  people  who  have  no  proper  idea  of  the  difference  of  colors. 
Examination  has  shown  that  this  proportion  exists  among  rail- 
way and  steamship  officials.  When  we  cross  the  ocean  and 
sail  up  the  English  channel  with  its  thousand  of  craft,  as  we 
are  in  our  cabin  unconscious  of.  danger,  the  man  on  the  look- 
out may  not  be  able  to  tell  a  red  light  from  a  green  one,  or  we 
may  have  been  journeying  on  the  railway  to  this  capital  behind 
an  engineer  who  is  equally  incompetent  for  his  important 
duty.  We  should  follow  the  example  of  Sweden,  and 
demand  such  a  searching  investigation  as  will  put  in  other 
positions  men  whose  visual  defects  now  render  them  useless 
and  dangerous  in  places  where  colored  signals  are  used.  In 
the  future  no  steamship  or  railway  should  be  allowed  to 
employ  a  lookout-man,  switchman,  or  an  engineer  who  cannot 
satisfactorily  submit  to  the  tests  for  the  perception  of  colors. 

Here  is  room  for  reform.  Here  is  work  for  the  closing  years 
of  the  nineteenth  century.  What  a  change  in  public  senti- 
ment is  to  be  made,  to  bring  about  a  proper  state  of  things  ! 
And  yet  how  necessary !  In  one  of  the  most  beautiful  hill 
regions  of  this  country,  or  of  the  world — in  a  spot  where  the 
sunrise  and  sunset  are  such  as  must  shine  upon  the  Delect- 
able Mountains — a  place  where  the  mists  that  roll  away  be- 
fore the  sunlight  disclose  green  forest-covered  mountain-tops 
that  are  the  glory  of  the  land — in  a  spot  where  the  water 
leaps  clear  as  crystal  in  cascade  and  waterfall,  or  meanders 
along  the  valley  in  the  placid  brook,  man  had  so  jieglected 
the  necessary  hygienic  arrangements  that  the  foulest  and  dead- 
liest materials  at  one  time  contaminated  the  water  and  the  air, 
and  with  this  brought  disease  and  death.  The  hotels  were  closed, 
their  visitors  scattered — some  of  them  dying,  however,  before 


22 

the  source  of  evil  was  detected.  Nor  is  this  a  solitary  in- 
stance; it  is  only  a  specimen  of  what  is  constantly  occurring. 
Epidemic  upon  epidemic  has  visited  communities,  notably  in  the 
South,  fever  has  constantly  broken  out  in  beautiful  valleys,  chil- 
dren have  become  the  victims  of  spinal  distortion,  sight  has  been 
impaired  and  lost  by  the  thousand  of  cases,  and  all  for  the  want 
of  scientific  and  medical  care. 

What  may  be  done  in  preventive  medicine  is  perhaps  no- 
where better  shown  than  in  the  exemption  of  our  city  of  New 
York  from  cholera  and  yellow  fever.  A  wise  system  of  quar- 
antine, rigorously  carried  out  by  an  intelligent  and  incorrupti- 
ble physician  with  great  executive  ability,  while  it  has  not  re- 
stricted the  freedom  of  commerce,  has  averted  epidemics  from 
a  large  population. 

Some  time  since,  three  representative  physicians  called  upon 
the  mayor  of  a  large  city  to  ask  him  to  appoint  a  doctor  upon 
a  board  having  charge  of  the  public  schools.  Among  the  score 
or  more  of  lawyers,  politicians,  and  business  men,  who  occupied 
the  chairs,  there  was  not  one  medical  man.  Several  political 
reasons  were  given  for  declining  this  modest  request,  but  the 
chief  one,  of  a  general  character,  was  that  physicians  could 
hardly  be  found  who  could  give  the  time  from  their  occupations 
to  this  preventive  work.  Assuming  that  this  was  an  honest 
reason,  it  shows  a  marvellous  ignorance  of  the  functions  of 
medical  men,  and  a  supreme  want  of  appreciation  of  the  fact 
that  should  be  evident  to  thinking  people,  that  the  physicians  of 
our  time  have  as  one  of  their  chiefest  functions  that  care  of  the 
community  which  shall  prevent  deformity,  disease,  and  death. 

The  recent  epidemics  of  yellow  fever  at  the  South  are  start- 
ling appeals  to  the  State  and  to  the  medical  profession.  Can 
nothing  be  done  to  prevent  this  awful  waste  of  human  life  ? 
Must  this  grief  of  a  desolated  population  continue  to  arise  \ 
The  experts  in  sanitary  science  have  told  us  that  thousands 
of  the  deaths  at  Memphis,  Grenada,  and  New  Orleans  were 
in  consequence  of  municipal  violation  and  neglect  of  well 
known  sanitary  laws.  Somebody  has  blundered.  From  what 
we  know  in  our  own  State  of  the  powerlessness  of  medical 
authorities  in  such  matters  as  the  cleansing  of  sewers  and 
streets,  it  is  to  be  feared — indeed,  it  is  known,  that  Tennessee, 


23 

Mississippi,  and  Louisiana,  like  New  York,  are  not  at  all  awake 
to  the  necessity  for  medical  supervision  of  the  housekeeping  of 
all  towns  and  villages.  The  principle  that,  in  order  to  promote 
public  health,  the  town,  the  village,  and  the  city  must  be  as  rigor- 
ously cleansed  as  the  body  of  an  individual,  must  be  taught  by 
us,  until  the  people  everywhere  understand  that  the  care  of  the 
public  health  is  one  of  the  highest  duties  of  the  officials  of  the 
State. 

How  can  we  hasten  the  day  ?  It  is  a  mistake  of  the  poets 
that  a  good  cause  must  certainly  prevail.  Many  an  honest 
and  wise  effort  for  the  advancement  of  the  human  race  has 
been  strangled  in  the  hour  of  its  birth.  Many  a  persecution 
has  successfully  stamped  out  a  growing  crop  that  promised  a 
blessing  to  its  time,  and  has  left  only  blood  and  desolation  in  the 
mark  of  an  iron  heel.  However  good  a  cause,  it  needs  advo- 
cates and  an  impartial  judge.  It  is  true  that  the  eternal  years 
of  God  belong  to  truth,  but  it  is  also  true  that  error  and  sin  are 
often  triumphant  for  a  time  that  is  interminable  to  its  victims. 

"  No ;  things  will  never  right  themselves. 
'Tis  we  must  put  them  right." 

Two  things  must  be  earnestly  seen  to  by  us,  if  we  will  hasten 
the  day  when  the  medical  profession  shall  assume  its  true  rela- 
tions to  the  State.  They  are  unity  of  action  and  a  jealous  re- 
gard for  our  reputation  as  a  profession . 

In  one  of  the  conflicts  of  opinion  in  the  medical  profession 
that  so  often  occur  in  all  large  bodies,  an  astute  and  experienced 
layman  of  New  York  remarked  to  a  medical  man  who  wished 
to  secure  his  aid  on  one  of  the  sides  which  had  been  formed  in 
the  profession :  "  If  the  gentlemen  of  your  profession  could 
simply  agree  with  each  other,  you  could  rule  the  city."  It  is 
certainly  true  that,  if  on  the  sanitary  and  medico-legal  questions 
of  the  day  we  were  united,  we  could  accomplish  in  a  few  years 
that  which,  with  our  present  modes  of  action,  will  require  de- 
cades. When  Benjamin  Franklin  was  endeavoring  to  arouse 
the  Colonies  to  resistance  to  the  exactions  of  Great  Britain,  he 
circulated  among  the  doubting  and  divided  patriots  an  emblem 
of  a  serpent  cut  into  thirteen  parts,  and  accompanying  it  the 
motto, "  Join,  or  die."     Whether  we  are  dissevered  or  united,  we 


24 

shall  still  exist  as  a  profession.  So  long  as  man  is  subject  to 
accident  and  disease  we  shall  form  an  integral  part  of  the  com- 
monwealth, but  the  prominence  and  proportions  of  that  part 
will  depend  upon  our  individual  integrity,  our  wise  delibera- 
tions, when  assembled  in  council,  and  our  unity  in  action  when 
our  deliberations  have  closed.  "We  are  an  isolated  class  as  we 
labor  in  the  tenement-honse  and  the  hamlet,  the  hospital  and  the 
palace,  always  with  the  suffering  and  the  dying,  harassed  and 
worn  by  our  self-imposed  weight  of  human  care,  and  our  voice 
may  seem  only  as  one  crying  in  the  wilderness,  as  we  lift  it 
for  reform;  but  as  we  gather  to-night,  the  honored  and  ex- 
perienced head  of  age  side  by  side  with  the  enthusiastic  smile 
of  youth,  the  dullest  can  see,  that  while  we  are  without  pomp, 
banner,  or  emblem,  we  may  yet  be  a  power  in  the  State. 

If  we  desire  to  be  an  influential  body  in  the  affairs  of  the 
State,  we  must  always  be  jealous  for  the  honor  of  our  craft. 
The  achievements  of  individuals  must  become  the  property  of 
the  whole  profession.  They  should  be  as  tenderly  and  safely 
guarded  by  us  as  are  the  battle-stained  and  bullet-torn  flags  of 
regiments  that  have  been  through  the  valley  of  death.  No 
personal  considerations  should  ever  induce  us  to  decry  the 
fame  of  men  whose  accomplishments  have  given  American 
medicine  an  honored  name  all  over  the  world.  If  there  be 
nakedness  to  cover,  let  us  step  backward  filially,  with  our 
faces  turned,  while  we  throw  our  garments  over  it.  With 
united  front,  let  us  who  struggle  for  the  prolongation  of  life 
and  the  mitigation  of  disease,  continue  our  advance  in  the 
same  column  with  those  who,  by  cultivating  the  soil,  by  humane 
and  wise  legislation,  and  the  administration  of  law,  by  the 
finding  out  of  many  inventions,  by  the  inculcation  of  the  prin- 
ciples of  morality  and  religion,  contend  for  a  land  and  a  time 
when  "  the  wilderness  and  the  solitary  place  shall  be  glad  for 
them,  and  the  desert  shall  rejoice  and  blossom  as  the  rose," 
and  the  Eternal  God  shall  wipe  all  tears  from  the  faces  of  men. 


COLUMBIA  UNIVERSITY  LIBRARIES 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE   DUE 

A 

Anne 

nil 

'- 

C2BI1  UOIMIOO 

RA395.A3 
Roosa 


(V 


R67 


The  relations  of  the  medical 
profession  to  the  state. 


JUi  3  (J  1^1 


C.  U.  BINDER 


'Tv'"*/ 


